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631- 589 -8100
34. -5 -1
BOX 15
01.568
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01.568
PUMAK so A n OF IKBAIZR
addmdmodmmosownodbs ca"MA N.Y. son
.,
C sn m
I P
HE 2WAW DOWN I STff = POOR
A Bull*et..Ho Ie-.Rqad Tattefson,
Two W: VIIImV
Wind. Burdick Farm 3 73-:,' 5 .8
-Tim m* Oak-
Raw-WWL--.
7/86
of plow Ammar
n Q
' -TAm n ri T) -r i i -N Brewster- Y- 4P 10509
Date' Subdivision'ARRroyed Res Enclosed.[] Aiiiminr
es Bence
—Im, Am 1 9 Ac .+ Somme, 0* LJ Dwa
FIE Vd�
Nomim 41. 4 D@@Wn Mao, G P D Q F PMNOOOmd='IsRoMOW wiles Mbeno0obd
Impmeft SOWNW gymillin 1, "mm d 12 9 0 no, T.,f IeIdi3---& 2` ROB fill
not yet determined To bele=okubo IW
Wailm,
an W s•p* Dd■ by not FQ Q-0- Api—Ong a
.0aw
I rea -W t that I &on wholli, and completely, responsible for the dft4n and local ion of the proposed systsim(s); 11 that the N ruts ecru di YI stem
above described will be constructed as shown on the approved arimmirneni there to and In accordance with the standards, rums;
County Oepirtment of Hank. and that on coma' lon.thersof & "Certificate Of.C*nAFUOMn C~.�i4nW-UU$fOctory to-the Commtssbrw of munhwAu
68 NOMON to the OOPMMild. and 4 Written OWW4W Will 60 furnished the ow"mr, his ■wA*sf.rs. heirs or amillims by the buiallse. that so builder win
MOM In good .OpsMOG AGNININION any OW of amid 1 MM disposel system durke the period of tkft(x) yaera "me"tely followire the date of the Now
&am of tie moo 1 of the Cort"kaft Of Construction Compliance of the Original tystaiw or a in therstol 2) that the drWW will dembell a6eve
WW,bo WaSlod So shown go the amplovell pion and that aid well will be ter aM�W* �aad rev�-=Ws—of the Putmont
C*W*.V Desertimema of "WHIL
iwwjcz I / %.. P.JE. X R.A. 7 /11
98 Mill 'West.-'Danbur CT 0681 051011
lgrn V I LWIW Me
APPROVED FOR COMTRUCTIONIS This 009rftSi Ox lik" tweyears-11`011% the data Issued unlan construction of the building'has been undertaken and is
morale for Cause nno 'be ammosamml or waddifled w mn co"O" *n;61ry by 'the o missioner of Human. Any chomp or alteration of construction
:tsmeAm a how F for disposal of OwAdk CW to water supply only.
WOO DIM
w-77 Tale
e
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
June 24, 1991
Greg Folchetti
Folchetti and Associates
98 Will Plain West
Danbury, CT 06811
Res Renewal
Schoberle
Bullet Hole Road
(T) Patterson, TM 0 73 -5 -8
JOHN KARELL Jr., P.E., M.S.
Public Health Director
Dear Mr. Folchetti?
Review of plans and other supporting documents submitted at this time relative to
the above - captioned project has been completed. Comments are offered as follows:
1. The SSDS plan is to be revised to a dosing system.
20 Volume of fill on plan does not appear to be correct. Please check and
revise accordingly.
3. Current construction permit for a sewage disposal system has not been
submitted.
Upon Receipt of a submission, revised to reflect the above comments, this
application will be considered further.
RM /pl
SSDSProposed
Very truly yours,
6E 6&� g
Robert Morris
Assistant Public Health Engineer
J. ROBERT FOLCHETTI & ASSOCIATES
ENVIRONMENTAL ENGINEERS
` P.O. BOX 374 BREWSTER, NEW YORK 10509. a Y 98 MILL PLAIN WEST
(914) 279-3346 DANBURY, CT 06811
FAX (203) 792 -2092 (203) 790 -6445
June 12, 1991
Mr. Michael Budzinski
Putnam County Health Department
110 Old Route 6 Center, Bldg. 43
Carmel, NY 10512
Re: Burdick Farm Lot #3 -- Schoberle
Dear Mr. Budzinski:
Pursuant to our conversation of May 2,_1991, I am enclosing the
letter of authorization and well permit application for Burdick
Farm Lot #3, as per your request. The expired permit number is
P- 45 -86. I would like to arrange a joint site inspection to
determine permit renewal status. Please contact us at your
earliest convenience to schedule the inspection.
JRF:kg
Enclosures
cc: File
Very truly you ,
J. Robert Folchetti, P.E.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL
PeRn PRRMTT A
(ALL LOCATION
Street Address
Bullet Hole Road.
Town/Village/City Tax Grid Number
Patterson 73 -5 -8
TELL OWNER
Name Mailing
Bert E. Schoberle 18
Address ®Private
Eastwood Rd Brewster, NY ® Public
USE OF WELL
1 - primary
2 - secondary
MRESIDENTIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED
® BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify
INDUSTRIAL— C9 INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT 5 gpm /#
PEOPLE SERVED 6 /EST. OF DAILY USAGE 450 Rat
REASON FOR
DRILLING
® REPLACE EXISTING SUPPLY
[3NEW SUPPLY NEW DWELLING
O TEST /OBSERVATION 13. ADDITIONAL SUPPLY
® DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
Domestic Water Supply
WELL TYPE
DRILLED ®DRIVEN
[]DUG
®GRAVEL
®
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Burdick Farm Lot No. 3
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: 5001
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
6�10�1N SEPARATE SHEET
/ `f! 86 f'1�Sd'6
(date) (signatu e)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirt3� (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a manner as not to degrade or otherwise contaminate surface or groundwater.
Date of Issue:
Date of Expiration
19
19
Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 6/10/91
Re: Property of Bert E. Schoberle
Located at Bullet Hole Road
(T) Patterson Section 73 Block 5 Lot 8
Subdivision of Burdick Farm
Subdv. Lot.# 3 Filed Map # Date
Gentlemen:
This letter is to authorize J.Robert Folchetti & Associates
a duly licensed professional engineer x or registered architect_
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
Signed'
Countersigned. -
0 er of Property
P.E. , R.A. , 051011 18 Eastwood Rd
Address
P.O. Box- 374
Address
Brewster, NY 10509
(914) 279 -3346 ;Zl- -O j74026445
Telephone
Brewster,NY 10509
Town
(914) 2 78 -20 18
Telephone
EPARTbMM'OF
.4PUTNAN COUNTY b HEALTH
.10512
4"eer to Prol4iae Pbr�t
j
-Rev. 3186 1 N.Y
DW�4 I& Health SeMbes.,din�,
a
Pa
CERTIFICATE OF COMP CE
#---
CONSTRUCTION PERMIT FORTS AGE DISPOSAL,SYSTEM
Town or Mage
Locat®d at bola- khke:1601
ion'Namo ubd t6t i -3-:--';�
❑
RiAslah ❑
wn Q�w
0 r/AppH RN
Cali Mile L
A --D ate 6f-P*ev1ousApproval
IH
M.g Ad it Cal Town' Z1
P`
Balldiug L
L C.,
Y, Depth Yo. us
-TYP Li
101
Number of Bedrooms .' Design Flow G/P� /D ®® PCHD Nodfieati6n IS Required Wben FUI is completed
Septic 1 L 4'cJL'- - a -JAI.
Sewerage Separate of
To be constructed by
Address
Water S401Y. lc Soy N l Address
or:, PrIvate'Sup i y.`DdHid-by
T,
O&r Req-
I represent that I am wft the system($);,. 1) - that �-the --.' separate, sewage disposal ,system
e!y. responsible C�!.", -R!Oppl.
the
ent there- ations ofL
aboie.descril�ep.wiil)_�bs constructed js�shi3wh on we-pPprpyed�amep4irn in, a�iccirjapi6 yii�ith th� siah'darils, :a Pultnam.
County ',.�'Deoaitriii�ntr,4'.if '- xbrnplkibh i hsiadf,* Nt'e kii iciia�,�Iof,"donsti (fit t,-L"fictor,y,::.to---,fhe-commissidner. of-.,Health'will'
I� I SU( der will
YT1i!h1td'1jhP 0 is -6�-;tha b'qiids�,,thit- said b4ll
be mitted- a %!, �f
SUP 'I'll- i t., 'i said 11 � ,
I d sewig?, (IiIiiiiithie',per mme1ja�e!y I Inj hadaia��oftfij,jjsu --
y. pliice W-goo ;ope am", - ollqw, , 1111, (,
prige appIr6yalx0f,", ii�ate. of Construct on Wijina 'Sys am or.any -rsp;8'irSJKeretci;-i) that"the, drill6d-'.Will abova"
409unam-ns, o vlt'pe qtnam
will be'located as show K,6& the approved ,. �ian:an that, Said --c-dr ance. 'Wit
County Department '.-�64 "Irlit'
Date'.'
PE RA
Address License No
a. as, ate an nd la,e. 'and is
APPROVED FOR ON TDUCTION:. This aPproyal., pii th, j d' n lisi ciinstrkiitio, A �df the buildinghas,.be , u or
ndeb h 6f 4onstrLiction
revo�awi`for rii6i or •m fied when considered Any. charigi'6r atteratio,
,�yAthi. c
disposal of -domestic I "wand a
for I) ad:
requires a new in V�t P` orariie
eQU W V
Date By Title
in
k U ,�1l6A 6,66# ` o i
From The Americana Collection by Northern Homes
The PatrickUTNA AUMMEk OF HEALTH
J." • .,c
^.4 xr-..cnt- n-- mr.r^rm +r , -rr!e� 4�a.�, �.r �c•.o.
A
The Patrick Henry
BREAKFAST
12x9
KITCHEN 12x10
w
LIVING ROOM 0 D ��
14x23 <
DINING
FOYER 12x12
11x7
First floor plan 729 x 45' overall
FAMILY ROOM
20x14
PORCH a CL
Second floor plan 389 x 24' overall
Approximate square footage ° living area
2105
column
GARAGE 20x22
wood beam
NOBT19ffWhile each photograph shown represents a standard model, certain
®��� LA ®� details and all masonry shown reflect the personal tastes of the
people for whom the house was built. For exact details, floor plans,
specifications and availability of masonry shown or implied, please
consult your dealer. Copyright 1984, Northern Homes, Inc.
... a,
.A,,
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM i FILE NO.
Owner�5%,JJjEyl Mob(-) ,tc Address �"r�c 'cx Aoe s•igiZ �Y
_Located at (Street.,, 14aU5 ->a�,D Sec. Block Lot
n Ica a nearest crosses ree
Muni cipality-T��nmfL- sot, j Watershed
SOIL
PERCOLATION TEST
DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
4.
IG LIS
1 77
3
1•: t c,, -
hole
UL zr,
its
Number
CLOCK
TIME
PERCOLATION
PERCOLATION
5
10,11-
Elapse'
p o Water
Water ve
No.
Time
From Ground Surface
in Inches Soil Rate
Start -Stop
''Min.
Start Stop
Drop in Min. /in drop
Inches Inches
Inches
If L
K-
- 2
14
IG LIS
1 77
3
1•: t c,, -
`i '• to 3o
UL zr,
its
5
10,11-
iO' j 30
- 14 I5
5 I.2.1_;
�4
SOAK4
- 2
8:4C�
If L
4
143-
10-;13 30
3 ILL 1 01 3d i5 15 A.a
5 30
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
t
DEPTH
G.L.
611
3-211
3.811
2411
3011
3611
541,
60"
61611
r7211
"(811
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE. NO-, HOLE NO. -HOLE NO. -
w V,
Loccv-
1,
0, ct 5i
Gock Cc
i5
t-00i
Ca .51'.
e_kw r Hq,
84 ICE"
INDICATE LEVEL ATVBICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS, MADE BY - Date
DESIGN
Soil Rate Usedl
6C)Min/l"Drop: S.D. Usable Area Provided _z;CC)O
No. of Bedrooms I- Septic Tank Capacity I Z'5-0 Gals.
Absorption Area Provided By 10c, L.F.x2411
4
01
C4 0
-Name o-- A Ssg)o__ wes-n-_s b19naLwP<ZK .903MS�
.Address-j-'>c).2x
�AL
0
THIS SPACE FOR .USE BY HEALTH DEPARTMENT ONLY: 0
I,JA
Soil Rate Approved sq. Ft/Gal. Checked by e
Putnam :County Department of Heali:h
Division `of.Environmental.Sanitat5_on
AFFIDAVIT CORPORATE ,OWNER APPLICATION
FORS PERMIT,,A*PPLICATIbN SUAMITTED TO
PUTNAM 'COUrTY }IEALTH :DEPARTMENT
TO Comrniss'oner. of Health In the :matter of a plication f
afp '0
I _..�GJ_ ��✓ — - — represent
that 1:-am an officer or mployee of the corporation.and am authori
to act" for
^(na e: o:f.,.'co ration)
having.o ices at �_ � IA�'Ll G_�i___„_______-
se off ic s are.
Z.. 7
President L. 27:7�i?
7Name..an address)
vice President
(Name .and Mdress)
Secret TY
..(Name and Address)
a` Zee "asurer — { — — — — —
— _ - — — - (Name and Address)-- —
and that I am and Will be:individually responsible. for. any or a ac
of:,the corporation with respect ko ahe a:pproyaa_ requeste an l
se
quent-acts relating. 'there'to.
Sworn to before me . this day Sig ed
of 19 YY Title - - -- — = - --
Norary 't'ublic.
RICHARD -1. GQLDSAND
Notary Public, State of New York.
Np:' 8573920
Qualified in Putnam Cty..No.. 1
T rm Expires. , 19.
C411i �
Corporate Seal
r
i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date April 11, 1986
?:e : Property of Skyview Development Co:._poration
Located at Bullet Hole Road
(T) Patterson Section 73 Block 5 Lot 8
Subdivision of Burdick Farm
Subdv. Lot # 3 Filed Map # Date
Jientlemen•
This letter ..is to authorize J. Robert Folchetti & Associates
: +.. duly .,licensed.,profe- ss'iona;l. engineer X or registered architect
(Indicate
;:o apply for a Gonstruction Permit for a separate sewage system, to
serve,thee.above noted, property in accordance with the standards, rules
ar re.gulations as promul ,agated-by- 'the.Commissioner of -the Putnam County
'.)epartment. of -to sign all.necessary papers on 'my behalf in
:onne.ction with this matter and to-supervise the construction of said
. >yst-em- or•'- sys•tems -in- -conformity with --the°•prov:; °sions - of -Article- 145 or
'I.47, Education Law, the Public Health Law, and the Putnam County Sani-
i:ary Code.
Very truly yours,
Telephone
He'eYdn Realty & Development Corp.
Root .Avenue
Address
Brewster, NY 10509
Town
914 278 -2111
Telephone
F-IvLlb RK M S a
PUTNAM COUNTY DEPART OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
(Name of Owner)
REVIEW SHEET - CONSTRUCTION PERMIT
BY:
(Street Location)
DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
G�`ri U
Ce
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions.- Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Ex:pansion__ Area .;shown;gravity..flow- ,.suff. - size -
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Hells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
louse Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
?ields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains -Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
)eptic Tanks
10' from Foundation
50' to Well
.5' Well to PL
2IiERAL
,egal Subdivision
; ubdivision Approval Checked
�c- approval SSDS Adj. Lots Checked
letland (Town/DEC Permit R & D)
rata On DDS Plans & Permit Same
4
Q' J.R. FOLCHETTI ASSOCIATES
Environmental Engineers
98 Mill Plain W. P.O. Box 374
Danbury, CT 06811 Brewster, NY 10509
(203) 790 -6445 (914) 279 -3346
FAX (203) 792.2092.._ _
TO Putnam County Health Dept
110 Old Route 6 Center Bldg. #3
Carmel, NY 10512
DATE 7/15/91
JOB NO.
ATTENTIO '"
Ro�ert Morris
RE:
Schoberie S.SDS
4
1
Septic .System Design Drawing prepared for Bert Schober
1
> WE ARE SENDING YOU 29 Attached ❑ Under separate cover via HAND DELIVERED the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES
DATE
NO.
DESCRIPTION
4
1
Septic .System Design Drawing prepared for Bert Schober
1
2
Construction Permit for Sewage Disposal System
THESE' ARE TRANSMITTED 'as checked below:
❑ For approval ❑ Approved as submitted
❑ For your use ❑ Approved as noted
> ❑ As requested ❑ Returned for corrections
❑ For review and comment ❑
❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US
• Resubmit copies for approval
• Submit copies for distribution
• Return corrected prints
REMARKS Letter from J Robert of heft i o John Karell reclardi nQ gygt-pm
design to follow.
COPY TO File -- 91 -008
PRODUCT 210.2 ® lea, Gmt^ sm OIOI.
SIGNED:
It enclosures are not as noted, kindly notify us at
gory L. Folchetti
e
---. - - - i
v PUTNAM COUNTY DEPARTMENT OF HEALTH
ev: 3/86 blvleloa of Environmental Health Servic", C"41, N.Y. lOS12 ;
Engineer Mast Provlde P -45-86
P C A.D., Peemftq
'OF CONSTRUCTION COMPLIANCE FOR SEWAGE'<DISPOSAL:SYSTEM• - ;s: `Paste±'.- on
'T
Nn or V e
=Bullet Hole Road Taz Map 73 8
Locnted at ---- Tslock Lot
Burdick Farm
Owner /appumnt.Name Bert `; S Ch ob a Y' l e Fotmedy Subdivision Name _ Sabdv. Lot N 3
Zrtutng Address 18 Eastwood Drive zIp '10509 Date Permlt issued 7/91
Brewster; NY.
Sepaeate Sewerage :System :befit' by M ac a l0 u S 0 Address, Patterson*, NY
Consisting of .. 1. 250 Gallon.Septic'.Tsaik and 93 7 L. ' F f. i t? l ds
t
Water.Sapplya ` - •= Pabllc Sdpply Ftom Address
ors X ; Private Supply DrWed by,i 1.1 Il r i 11 i n l Address - -B rPw s t- A r-,- NY
Residence' �. rr7
Buildhsg Type Has Erosion Control Been CompletedY YP S •"
Number of Bedrooms 4 ' Has Garbage GrWder Been InstalledY Nn
± X C !
.. " Other: Regalrements f?
V ' f ice! +?+..
i`certify;.that•the syetem(e) as :liated.serving'the above premises were constructed essenfially as.ehown on: the plane of the com l4ptedlworlL( comes
of which are.attaclied)', and-in accordance with the standards,.rules and regal' one, in accord a with the tiled plan', and the permit ^�6atu d the
[?utnam Count Dekaz t Or Health.
Date
Certified b P A,
x Address License Nb' J
Any person occupying premises served by the above system(s) shall promptly such tlon�as maybe neceaaaiy to secure th_ • correctkM of eft unsanitary •
'conditions resulting from such: usage. Approval of the operate Owsra _ aysto _ .shalt become, null,antl void as 1oon.as v pubs,: sanitary rawer becomes'
available and.the approval of.the. private water supply shallbecome ou ra o :when a publle .wa supply becomes available, Such 'approvals are
subject ;to<m fleatlo or` ehange' when, do the Judgment of the C m Is r of Health, sue lion, modification or change Is nee ry.
Date Eiy Title
Is
PURQM COUNTY DEPARTMENY'r OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
l
owner or Purchaser of Building
17161M,q--'n1 47-v' A/V-� . —
uildding /Constructed by ,s
Location - Street /0
Municipality
Building Type
Section Block Lot
Subdivision Name
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as shown on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by me which fails to
operate for a period of two years immediately following the date of approval of the
"Certificate of Construction Compliance" for. the sewage disposal system, or any
repairs made" by, -mom tio- -siTch "system, except where the failure- to operate- properly -is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate
caused by the willful or negligent act of the occupant of the building uti 'z'ng
the system.
V 19 Signatur
Title
Address
rev. 9/85
mk
Corporation Name (if Corp.)
/Lr h
Addr
s
Z5 ,31
Lot .3 Burdick Farm
WAILK bYbILM KL(-URU
Date ... June .... 6 th,.. 19....8.7..
..Customer .. . ........... HEE-LA.-N°-.;RE-A-L-T.-Y,-.n--.&-,-DE-V.E.LOPM.ENT ....... ......
Mail Address .......... Rt.e .._. 6.,,._ B.re.w.s.t.e.r . ................................. Phone ....
Jobsite ................. ... 5RLLZT .... HOLE .... RD .. ......... P.at.t.er.son .............................................
WELL
385 6 12 35 91
Depth .................. Dia . .................. Flow .................. Static Level .................. Well Casing ..................
PUMP
Make Q.0V145 Model No....7 0741&r. No......110.2.3.216 .................... H.P. .3/4
230 12/3 ill
Voltage ............................... Cable ........................ Drop Pipe Size ................ Drop Pipe Lg . ..... 240- ft.
Tank SiNS.951 ... Offset Pipe Size ... 1.11 ..... Offset Pipe Type ...200. Drop Pipe Type n#80
psi
Installation Date ...._....8./1,1 / &7............ Warranty ... 110 ........................................................................
WELL LOCATION DIAGRAM
Martinson
Pitless ................... . ............... ........ NORTH LOT. POURED FOUNDATION.
Well Tile ....... . ...... . .. . .
MILL DRILLING, INC.
N.
CHEMICAL
PHYSICAL
DIOLOOICAL
ELLIS A.. TARLTON LABORATORY
DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC.
34 PLEASANT STREET DANBURY, CONN. 06813 -2328 METH • ODOLOGY A►ATER
P.O. BOX 2328 203- 748 -7903 APHA - EPA - AA3TM
REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER
4AME AND
\DDRESS OF F— Mill Drilling Inc.
'ERSON TO
IECEIVE pyt•nam Avc+..I1Ltp
IEPORT
I Arewster, N.Y I0544
DATA
souRCE of 3AMne Water Supply
Heelar Realty Co.
Bullet Hole Rd.
Patterson, N.Y.
- Lot #3 -
DATE OF cmLEcTION 7/16/87
COLLECTED SY
Mill Drilling
drooen ion
COLOR
TURBIDITY
DDOR
CORROSION INDEX
OISSOLVED.f;OLIDS
w+oentralion
LANGELIER
1)
RYZNAR
I'm
Mp /L
Alkatinity, as C400 a
Fluoride (F)
Sicarbortate
Nitrite
Mg /L
MO /L
MOIL
NITROGEN
AlKalinity. as CaCO3
Chlorine Retidual
+
Carbonate
h/STtTUEN7S
Nitrate
Mg /L
MG /L
Mq /L
ITROGEN (N)
Total Hardness
Conductivity
as ��3
Ammonia
Mg /L
Mg /L
Maaontohos/cm
Mg /L
Iron as Fe
Mg /L
Mp /L
Chleridet as CL
Mg /L
Manganese as Mn
Mg /L
Mt;lL
Detsrq*M as MSAS
MOIL
Sulfate as SO4
Mp/L
_
MOL
...M. Arithenvic_.nean .of -all standard samples eutnined per month using the membrane . filter..(ethnique shell. not. Weed MEM6iiANE 1117LICK ICU]
e •colony-pof 100m1: Gotitorm colonies- per standard - IamptY• shall not ^ext2ea 3730rti1, t /ti30tiii.- 1 /20pmT, - 0-13 /50611fl. C*Iilorm. Colo~ 1Aa1L.. ...-
.: (a) Two consecutive samples: (b) More than ohs standard sample when Less than 20 are examined per month: or (d)
are then five per cent of the samples when 20 or more are examined pet rrcnth. 0
TAE TIME THE SAMPLE WAS SUBMITTED:
1. The results of the analysis of this sample were satisfactory end met requirements +ore potatxc water.
2 The results of the ana is of this sample were satisfactory for a potable water b.t certain of the chemical w
lys pttyaiCll tons!ituents were high. These aro as follows:
3. This sample was not satisfactory since it did not meet the bacterial requirements !x pc:atNe wiper. The presence of organisms of the eotifortn group Ina sample of potable water is
vndersirabte end. while not necessarily indicating the presence of any disease ; :aa:,cr. y organisms, does indicate that svCh contamination might sum" .o the same extenL The
presence of orgartisens of the cafffdrm group may also indicate that the treatment *as 'idt adequate at the time the sample was collected.
e. Thts sample was unsatisfactory as a potable water because certain Chemical or pnysical constituents were above ftCaptable limits. Tifese are as toibwi
COMMENTS
The bacterial analysis showed no organisms of the coliform group at
the time the sample was collected which indicates the water potable.
x• �-�J
n --1 c
r..-
WELL UUMFL1';' ITN KLruml
Office Use Only
aw .�
DEPARTMENT OF HEALTH
-.
– Division - - Of. - Environmental Health. Services...... ..
A
PUTNAM COUNTY DEPARTMENT OF HEALTH�-
STREET ADDRESS: wNw,l 1 ItY TAx GRIO NUMBER: -
IWELLLOCATiON
Bullet Hole Road, Patterson, New York. lot 3
WELL OWNER
N E: ADDRESS:
fteelan Realty & Development, Rte, 6, Brewster, NY
PflIVATE
p PUBLIC
USE OF WELL
RAC RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
1 - primary
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
2 - secondary
C1 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm.INO. PEOPLE SERVED 3 / EST. OF DAILY USAGE gal.
REASON FOR
Ka NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
DRILLING
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
385
WATER LEVEL 35 ft.
6/17/87
1
WELL DEPTH ft.
STATIC
DATE MEASURED
DRILLING
❑ ROTARY )Q COMPRESSED AIR PERCUSSION D DUG
EQUIPMENT
❑ WELL POINT ❑ CABLE PERCUSSION D OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING, XRX OPEN HOLE IN BEDROCK D OTHER
TOTAL LENGTH ft.
MATERIALS: >Q STEEL D PLASTIC ❑ OTHER
CASING
go
LENGTH.BELOW GRADE ft.
JOINTS: D WELDED A%I THREADED ❑ OTHER
DIAMETER in.
SEAL:"CEMENT GROUT ❑ BENTONITE D OTHER
DETAILS
19 WEIGHT PER FOOT lb./ft.
DRIVESHOE:r(YES ONO
LINER:OYES ONO
DIAMETER (in)
SLOT SIZE
LENGTH (1t)
DEPTH TO SCREEN (ft)
DEVELOPED?
SCREEN
DETAII S
FIRST
O YES ONO
�_
_ _ . __ _
SECOND
HOURS
GRAVEL PACK
O YES
GRAVEL
DIAMETER
TOP
BOTTOM
O NO
SIZE;
OF PACK in.
DEPTH ft.
DEPTH It.
WELL YIELD TEST If detailed pumping
it more detailed formation descriptions or sieve analyses
'WELL LOG are available. please attach.
METHOD: O PUMPED I tests were done is in-
DEPTH FROM
Water
well
COMPRESSED AIR ; formation attached?
:OYES ONO
SURFACE
i ^9
Dia-
deter
FORMATION DESCRIPTION
Ct10E,
O BAILED 0 OTHER
ft.
ft.
WELL DEPTH
DURATION
DRAWDOWN
YIELD
Land
Surface
ft.
hr. min.
It.
9Cm.
80
385 Ives
6 1
MediLm to hard grey granite-_,
385
6 -
300
12
_
WATER A CLEAR TEMP.
-- r
--1
1
-'
I
H
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? X)] YES 0 NO
ANALYSIS ATTACHED? WES 0 NO
STORAGE TANK: TYPE Diaphram
CAPACITY 62 GAL. 16
PUMP INFORMATION
TYPE Submersible CAPACITY—
WELL DRILLER NAME MILL DRILLING, o
MAKER moulds D j}J, 2250
&V16/87
ADDRESS Putncm AVenue
MODEL 7 Cr1U7 VOLTAGi 51J HP�/
Brewster, NY 1 resident
1
Ro r o ,
.BULLET HOLE ROAD
SCHEDULE OF DISTANCES
FROM TO 1 49'
FROM TO A 55'
a 2 47'
a a 2 59'
a a 3 55'
a a 3 60
n a 4 53'
n a 4 63'
5 61'
n a 5 84'
o n 6 59'
o a 6 68'
a a 7 67' .
a a 7 70
a a 8 65'
n a 8 73'
u n 9 73'
a n 9' 74'
a a 10 71'
n n 10 77'
a a 11 78'
a 1 11 81'
a a 1,2 77'
a a 12 83'
n a 13 84'
n a 13 86'
o. a. 14 83'' .
a a 14- 88'
a a 15 90'
a 15 . 92'
a a 16 90'
n n 16 94'
n a 17' 99'
0 17 1'32'
a a. 18 93'
a a 18 129'
a a 19 87'
a a 19 "123' .
a a 20 82'
a n 20 121'
a a 21 77'
a o 21 1,17'
a a 22 70'
a .22 112,'
a a23 66'
a a23 110'
a 124 61'
a e24 107'
a v25 89'
a .25 44'
a n26 . 93'
a o26 51 '
a 127 96'
a a27 56'
a a28 99'
a a28 62'
a .29 105'
'j)'30- ..11.0_ - . _ _ _...
a a30 75'
a 131 11.5'
a a 31 81'.
a a32 119'
a 132 87' ,
) 3-5
ICA
if
FROM A, TO SEPTIC TANK 'INLETo 18'
FROM 8 TO SEPTIC
a SEPTIC TANK OUTLETo 17'
a a SEPTIC
a s DIST. BOX INLET u 44'80
DIST.,
a 6